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The optimal treatment for large osteochondral defects of the talus or secondary treatment after failed primary surgical treatment is yet to be determined. A metal implant with a diameter of 15 mm has been developed for treatment of these lesions of the medial talar dome. The approach by means of a medial malleolar osteotomy and the implantation technique are outlined. The surgical technique is safe and reproducible, and short-term clinical results are promising.